An eleven year old boy with autism was admitted to a hospital because he became less responsive. This followed a recent admission to another hospital for a skin abscess. He was found to have a large liver. Blood tests showed that he was acidic and had high blood ammonia and high blood bilirubin (sign of liver failure). The high blood ammonia was most likely responsible for his reduced level of alertness.
Further blood testing showed evidence for lactic acidosis*. One cause of lactic acidosis is thiamine (vitamin B-1) deficiency, so he was started on thiamine 25 mg/day for 9 days. The level of lactic acidosis was improved within hours. The cause of the vitamin deficiency was later clarified that for several years he would eat only chicken “nuggets” and occasional French fries from a particular outlet. Those foods are very low in vitamin B’s.
Liver biopsy showed non-alcoholic fatty liver. Blood levels of vitamin A, pyridoxine (vitamin B-6), iron, and copper were all low. He had a grand mal convulsion on day 12 of hospitalization. Pyridoxine (vitamin B-6) was started with a 100 mg. injection, followed by a daily dose. His level of alertness improved with the vitamin B therapy, even though the brain scan showed evidence for cerebral atrophy (reduced size of the brain). Pyridoxine deficiency can interfere with neurotransmitter production and can cause grand mal seizures as the result. He was placed on nasogastric tube feedings until a gastric tube could be surgically placed in his stomach to assure adequate diet. He was discharged to a chronic care facility.
CONCLUSION: An 11 year old boy with autism had liver failure and neurologic symptoms after 4 years of a vitamin deficient diet. He improved with vitamins and micronutrient treatment, especially thiamine and pyridoxine. The deficiency was caused by his refusal to vary his diet.
NOTE: *Lactic acidosis is caused by elevated lactic acid in tissues. It causes muscle cramps with heavy exercise.
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